CIS Mentor Form
First Name
Last Name
Email
Telephone
Cell phone
Age	18-29 30-39 40-49 50+
Number of CIS units completed
CIS courses in which currently enrolled
Hobbies/Special Interest

Program Goals
Certificate Web Development Computer Network Administration Telecommunications Networking Technology Other	Associate Degree Web Development Computer Network Administration Telecommunications Networking Technology Other	Professional/Vocational Goal Transfer to 4 year school Full time employment Part time employment and additional education
If other certificate,	If other Associate Degree,

General times of availability for meetings
Mornings Monday or Wednesday Tuesday or Thursday Friday	Afternoons Monday or Wednesday Tuesday or Thursday Friday	Evenings Monday or Wednesday Tuesday or Thursday Friday